Ca ovary

GROUP D
Dr.Tarig Hassan

Introduction
.

The incidence of Ca ovary 62/100,000 women.

Increase in women more than 40 yrs
The maximum incidence occur in 80 to 84 yrs old
Ovarian cancer is the 5th commonest cancer among Us
women

-about 15,000 women die every year in US from CA ovary.

- white women more than black women.
- .Not the commonest but the most serious gynecological
tumor. (silent killer)

Risk factors
.Age- 1
Family history-2
:Ethnicity-3
white women<
black women &Asian>
Diet- 4
.INHERETED GENE MUTATIONS-5

(.BRCA2( & )BRCA1)

percent to 10 percent of ovarian cancers 5

inherited syndrome called hereditary nonpolyposis

.colorectal cancer )HNPCC(

Risk of ovarian cancer associated with-

HNPCC is lower than is that of ovarian cancer
.associated with BRCA mutations
Menstrual history/pregnancy- 6
:history/infertility
early menstruation&late menopause Nulliparityhaving a first child after age 30 Multiple pregnancyrisk Birth control pills40-50% in risk -

:Fertility drugs-7
:Ovulation induction
clomiphene citratemenotrpinsLMP
Androgens-8
Danazol increases androgen levels
Estrogen and HRT-9
Talcum powder-10
carcinogenic??
Other cancers-11
Smoking and alcohol use-12

Signs&symptoms
..Clinical presentation
:Early stages of disease
fatigue
Bloating
constipation
Difficulty eating or feeling full quickly
indigestion
back pain
chronic cough
menstrual irregularity
vaginal bleeding or discharge
:Late stages of disease
Abdominal mass & ascites
abdominal pain
unexplained wt loss
cachexia
pleural effusion

Screening methods
for CA ovary
Why screening methods?
Vague symptoms
Not easy to select high risk group
U/S:not useful as a primary method
Ca-125

DIAGNOSIS
If the physician suspects ovarian cancer, medical history, physical examination
and various tests performed to diagnose it.
A- History:
1. Regularity of menstrual period
2. Previous pregnancies
3. Contraception
4. Breast feeding history
5. Previous cancer history
6. Family history of ovarian cancer
B- Examination:
1. General examination

2.Abdominal examination:
- Signs of distention
- Dilated veins
-Tenderness
-Shifting dullness

C- Investigations:
-Routine examination:
Complete haematogram
RFT
LFT
Random blood sugar
Chest X ray
Echo may be needed
-imaging:
U/S
CT-scan
MRI

-Ovarian Cancer Staging Is Done by

laparotomy and Biopsy Taking. The Stages
Are:
1) Stage I:
Limited to One or Both Ovaries.
2) Stage II:
Pelvic Extensions or Implants.
3) Stage III:
Microscopic Peritoneal Implants Outside
of the Pelvis, or Limited to the Pelvis With
Extension to the Small Bowl or omentum.

4) Stage IV:
Distant Metastases to the Liver or
Outside the Peritoneal Cavity.
* Stages I,II, and III Are Further Divided Into:
Stage I:
Ia:
Involves One Ovary, Capsule Is Intact, No
Tumor on the Ovarian Surface and No
Malignant Cells in the ascitis or in the
Peritoneal Washing.
Ib:
Involves Both Ovaries, No Tumor on
Ovarian Surface, and Negative Washings.

Ic:
tuomor Limited to the Ovaries With Any of
the Following: Capsule Ruptured, Tumor on
Ovarian Surface, and Positive Washing.
* Stage II:
IIa:
Extension or Implants Onto Uterus or
Fallopian Tubes With Negative Washings.
IIb:
Extension or Implants Onto Other Pelvic
Structures With Negative Washings.

IIc:
Pelvic Extensions or Implants With
Positive Peritoneal Washings.
* Stage III:
IIIa:
Microscopic Peritoneal Metastases
Beyond Pelvis.
IIIb:
Macroscopic Peritoneal Metastases
Beyond Pelvis Less Than 2 Cm in Size.

:IIIc
Peritoneal Metastases Beyond
Pelvis More Than 2 Cm or Lymph Node
.Metastases

classification
;Types of ovarian tumors
Most of these tumors are benign (non cancerous) and.
never spread beyond the ovaries
.the others are malignant, which can metastasize.
ovarian tumors are named according to the kind of cells.
.the tumor started from
;types.
epithelial tumors ( most common)-1
germ cell tumors-2
stromal tumors-3

epithelial tumors
1- benign epithelial ovarian tumors. (most common);
Serious adenomas
Mucinous adenomas
Brenner tumors
2-tumors of low malignant potential (LMP)
.(affect women at young ages)
.it grows slowly and are less life threatening.
3-malignant epithelial ovarian tumors;
.about 85% to 90% of ovarian cancer are epithelial ovarian carcinoma
Mucinous
Endometrioid
Clear cell
Undeffrentiated
.it tend to grow and spread more quickly than others.

Germ cell tumors

life threateningabout 5%of ovarian cancers are GCTthe most common GC, Teratoma, Dysgerminoma, endodermal sinus tumors andchoriocarcinoma
;TeratomaBenign form called mature teratoma, but the malignant one called immature teratoma *
The mature teratuma is the most common and Affects women of reproductive age*
can contain different kined of benign tissues including bone ,hair and teeth
the immature teratoma occur in girls and young women<18*
:dysgerminomaThese are rare affect teens and 20s*
its malignant ,not grow or spread very rapidly*
endodermal sinus tumors and choriocarcinoma
very rare,affect girls and young women*
grow and spread rapidly*

Stromal tumor
about 5-7%most of them are granulosa cell tumor in older than 50 yrs old,but 5% occur in 1/2-<
young
:Types of malignant
granulosa cell tumor.granulosa theca tumorSertoli -Leydig cell tumors-

Treatment
surgery
.laprotomy- needed for diagnosis and staging of cancer
fluid aspiration for cytology-in chronic cases
,Types of surgery
Oopherectomy
Salpingectomy
Hysterectomy
Cystectomy
Omemtectomy
Debulking- in metastatic cases
?Is patient able to withstand the surgery

Chemotherapy
Very important esp beyond stage 2
.Chemical debulking- chemo before surgery
Chemo drugs
.Cisplatin, paditaxel, carboplatin
Side effects
Nausea, vomiting, diarrhoea, alopecia
Anaemia,thrombocytopenia, leukopenia
Nephrotoxicity, neurotoxicity, ototoxicity
Peripheral neuropathy

Radiotherapy
.Usually ineffective, however is sometimes used in recurrent cases

Prognosis

Poor prognosis
1. Early detection
2. Screening test
3. Late presentation
Probably germ cell tumor has better
prognosis

Complications
Spread of the cancer to other organs Progressive function loss of various organs AscitesIntestinal obstructions

Samih Ahmed Alawi

Noon Salah Eldin
Nusaiba Al Tigani
Ghada Babikir
Sara Abbas
Nihal Hanafi Abdallah
Noha Salah Eldin
Aula Muntasir Mostafa
Khalid ElSadig
Alaa Eldin Abdelbadee
Rouaa Shouayeb
Dalia Amin Osman
Nadeen Magdi Faried
Mohammad Ahmed Sayid

Directed by Dr.Tarig Hassan

Thanks